Hemostatic clip and applicator



g- 26, 1969 E. B. MCDERMOTT 3,463,156

HEMOSTATIC CLIP AND APPLICATOR Filed May 27, 196 5 2 Sheets-Sheet 1EDWARD B, McDERMOTT ATTORNEY g- 1969 E. B. M DERMOTT HEMOSTATIC CLIP ANDAPPLICATOR 2 Sheets-Sheet 2 Filed May 27, 1965 FIG IO INVENTOR EDWARD B.McDERMOTT BY Low'M-Q J ATTORNEYS United States Patent 3,463,156HEMOSTATIC CLIP AND APPLICATOR Edward B. McDermott, 23 Flower Lane,Manhasset, N.Y. 11030; Bernard Rackear, executor of said Edward B.McDermott, deceased Filed May 27, 1965, Ser. No. 459,151 Int. Cl. A611)17/12; B65d 63/10 US. Cl. 128-325 13 Claims This invention relatesgenerally to hemostatic devices and more particularly to a metallic clipand applicator therefor.

Surgical operations normally require the tying off of considerablenumbers of blood vessels during the making of an incision. Because nosuitable clip of acceptable characteristics has been available, handtying with standard suture materials has been a necessity. In deepsurgery, hand tying is difficult for the surgeon to perform, especiallywhere space is anatomically limited. The positiveness of such ligationsis also a source of serious concern to the surgeon. At lesser depth, thehundreds of bleeders which the surgeon must tie off take up as much asthree-quarters of the total operating time.

It is accordingly an object of this invention to provide a positive,quick-closing hemostatic clip.

Another object of the invention is to provide a metallic clip whichcloses and locks merely by the application of pressure at the jaws of anapplicator device.

Another object of the invention is to provide a hemostatic clip which iscompatible with growth processes such that the clip is accepted by thebody over a considerable period of time.

A further object of the invention is to provide an improved surgicalapplicator for a hemostatic clip of improved speed and certainty ofresult in tying ofi blood vessels.

A still further object of the invention is to provide an improved methodof hemostasis.

These and other objects of the invention will be evident as thedescription proceeds in connection with the drawings in which:

FIG. 1 is a perspective view of the jaws of an applicator clamp, a bloodvessel, and a clip being closed thereon, according to this invention;

FIG. 2 illustrates the jaws of the clamping device of FIG. 1 and ahemostatic clip to be applied thereby, not yet inserted;

FIG. 3 is a sectional view of the clamping jaws, blood vessel, and clipof FIG. 1 inserted therein;

FIG. 4 is a sectional view of the apparatus as in FIG. 3 with the jawspartially closed;

FIG. 5 is a sectional view of the apparatus of FIG. 3 in the closedposition;

FIG. 6 is a cross-sectional view of a preferred form of stock formanufacture of a hemostatic clip;

FIG. 7 shows an alternative form of the hemostatic clip;

FIG. 8 shows an alternative form of hemostatic clip stock;

FIG. 9 shows an alternative form of the applicator including an open-jawposition lock; and

FIG. 10 shows details of the positioning lock.

The objects of the invention are achieved by the use of an applicatorand a formed clip of somewhat flattened wire-like material arranged tobe folded together to pinch off blood flow through veins or arteries. Aself-locking feature is provided in the construction of the clip so thatit is held closed in the manner of a safety pin, but of simplerstructure, and of material suitable for temporary or permanent usewithin living tissue. A special applicator provides ease and speed ofperforming the clamping operation at the time time locking the clasp inthe closed position. A clip of round-edged flat material is preferred toavoid damage to surrounding tissue and is preformed with an open sidearranged to be closed firmly and locked at one end while leavingthroughout the body of the clip an open space sufiicient for the wall ofthe blood vessel being closing olf. Application is by a simple squeezingoperation at the handles of the applicator; while premaiurlec closing ofthe clip is prevented by a jaw-positioning Proceeding to a more detaileddescription of the applicator, attention is directed first to FIG. 1wherein there is shown at 10 an applicator of suitable type, hereillustrated as a set of forceps somewhat like a conventional temporaryblood vessel hemostasis clamp, suited for manual operation to close ablood vessel. Such a clamp, when modified to serve as an applicatortool, is provided with contoured jaws 11 and 12 attached togetherthrough a suitable pivot point 13, or otherwise through multiple pivotpoints to provide a parallel-jaw operation. In either case, it isconvenient to employ narrow jaws of stainless steel, or the like,extended from handles as at 14 and 15 by which the jaws are operated.Conventionally, in such clamps, jaws 11 and 12 are disposed at an offsetangle to handles 14 and 15 in order to facilitate operation of the jawsadjacent to the side of an incision. Jaws 11 and 12 are shownillustratively of a shortened form of applicator.

Applicator 10 may be a hemostasis clamp of conventional type somewhatmodified to exhibit channeled jaw surfaces 16 and 17, and may be slenderand elongated to reach deep within an incision without occupyingexcessive space therein. As will be seen in FIG. 2, surface 16 has a.straight, flat-bottomed channel 21, nearly rectangular in section,running longitudinally from the tip of the jaw. Surface 17 on theopposing face is of the same construction. The opposing channels 21 and22 are laterally parallel and have nearly coincident center lines whenclosed. The depth of each channel is the same as the thickness of thestock of hemostatic clip 20. Each channel is sufficiently wider than thehemostatic clip to permit longitudinal motion therein.

In FIG. 3 may be seen pin 19 rising perpendicularly from the bottom ofgroove 21 towards clearance hole 18 in opposing jaw 11. Hole 18 and pin19' are preferably located on the lateral midlines of grooves 22, 21.Pin 19 acts as a locator stop for hemostatic clip 20' when it isinserted into the applicator jaws. It is positioned according to thedimensions of the hemostatic clip to be applied thereby so that thehooked end of portion 23 is safely back from the tip of jaw 11. The pinalso acts as a firm stop behind hemostatic clip 20 when a vessel isbrought into the hemostatic clip and pressed against the inner wall nearclip bend 28, as seen in FIG. 5'.

In addition to the flat-bottomed grooves and the stop pin describedabove, the applicator, as adapted from a standard hemostasis clamp,differs in another important feature, more particularly shown in FIGS. 9and 10. The jaws 11 and 12' correspond to jaws 11 and 12 of FIGS. 1 and2, while handles '14 and 15 correspond to handles 14 and 15. While theform of the clamp differs considerably from that of FIG. 1, itillustrates an alternative type of clamp adaptable as a clip applicatorin generally the same manner, but includes an additional feature servingto expedite the completion of blood vessel tie-oif, and avoiding certaindifliculties which would otherwise arise.

One of the problems with U-shaped or V-shaped clips presently in use isthat they frequently fall from the applying forceps before they can beapplied to a vessel. The hemostatic clip described hereafter fits sotightly into opposing channels 21 and 22 that it cannot be dislodgedduring ordinary surgical procedure. However, if a nurse during loading,or a surgeon before clip application, should accidentally close theforceps jaws partially, the clip would then be partially closed and uponrelease of the accidental pressure, the clip would fall from the jaws.To prevent this, a position lock is added to a standard clamp. In thisform of clamp a strong and rigid conventional arrangement includes atongue portion 41 which is a broadened and somewhat thinned section ofthe handle 15' which is positioned within a slotted portion 42 of thehandle 14. One of the handles may be provided with a return spring 43tensioned to cause reopening of the jaws when they have been closedduring use.

The open-jaw stop or position lock may be fitted to one of the handles,and consists of positioning member 44 mounted on the inside of thehandle being fitted with hole 45 to receive screw 46 passing throughmember 44 to retain the same in rotatable position about the axis of thescrew 46 mounted perpendicular to the handle. Handles 14 and 15' areappropriately cut away to receive the body of the positioning memberbetween the handles when closed. However, a spacing land 47 is providedat one side of the member 44 having a suflicient height so that thehandles can be closed only suficiently to grasp the open clip betweenjaws 11' and 12. Adjacent spacing land 47 there is a flush portion 48which, when placed between the handles, permits their complete closingto clench the clip in the jaws '11 and 12. Preferably, screw 46 isprovided with a spring washer 49' shaped to provide tension on themember 44 thereby to retain it either in the open or the closed positionand thereby to make the spacing land 47 effective to prevent thepremature closing of the jaws beyond a predetermined open-jaw spacing,or to permit the full closing of the jaws when the flush land 48 liesbetween the handles. Member 44, when in the closed position as at 51,provides a position lock against which considerable pressure can beapplied as the surgeon grasps the clamp and prepares to apply the clipto a vessel, while the released position as shown at 52 is the positionof member 44 when the hemostatic clip is to be closed on a vessel.

Clip 20 is preferably formed of a stainless steel such as the alloyknown in the trade as 316 L, which is particularly suitable for thepurpose since it is compatible with body processes. When made of such amaterial and suitably shaped without sharp or cutting edges, a foreignbody of this type and configuration may be permanently retained withinthe flesh, or may be removed at the close of an operation. Such a clipconstitutes a highly eflicient hemostasis device when used inconjunction with the above described applicators and is found to beeffective in saving time and sometimes the life of a patient. Othermaterials may be substituted for alloy 316 L but these materials shouldbe selected for compatibility with the body and must possess suitablecharacteristics of rigidity and bendability.

Preferably, the clip stock is of flattened metallic wire such as wouldbe produced by taking a standard round wire of the selected alloy andpassing it through pinch rollers to produce flattened surfaces onopposite sides, leaving rounded edges as at 38 and 39 of FIG. 6. Wire offlattened form is utilized to prevent any cutting through of the bloodvessel when the jaws are firmly clamped together, and has desirablyrounded edges as at 39, serving both to prevent any tendency to cut thevessel 30 or the surrounding tissue if left in place bearing against theflesh. The material from which the clip is made is preferably annealedso that the clip may be bent for closing and locking without appreciableelastic return. It may be formed of alloy wire drawn to a shape, asillustrated in FIG. 6 or FIG. 8, or may be round wire rolled flat in onedimension as in FIG. 6, or in perpendicular dimensions as in FIG. 8. Ineither case, it has a broad inner face and rounded edges.

Clip 20 is preformed to have a generally straight portion 23 extendingthroughout substantially half the length of a suitably precut strip.Portion 23 becomes the back of a clip resembling a safety pin of whichthe front closure member 24 is illustrated as bent about an arccomparable to the length of the straight portion 23. Thus closureportion 24 has one end which may be linearly extended into hook 26 asportion 24 becomes flattened to the form shown at 25 when the jaws areclosed. While portion 24 is illustrated as arcuate, it may, of course,be of other shape such that its overall length, while bowed, isinsufficient to reach from its junction with portion 23 to hook portion26 at the opposite end of portion 23. Hook 26 is preferably formed bybending the strip about a suitable radius 27, for example, approximatingthe lateral dimension of the flattened wire. Closure member 24 is bentat the opposite end of back portion 23 about a radius 28, preferablyapproximating four times radius 27.

It will be noted that the clip has a reverse bend 29 near the hook suchthat the bend 26 of the hook portion is offset from the linear portionby an amount approximately double the thickness of the wire. Thisconstruction facilitates entry of the vessel 30 and, by turning theopening in hook 26 from a sidewise direction to more of an upwardposition, permits point 33 to descend into the hook more easily. Points32 and 33 are brought into locked engagement wherein the clip portion 35is clenched between hook portions 34 and 32. A clamping action resultingfrom closing jaws 11 and 12 causes closure of the clip and flattening ofthe bend in closure element 24 while leaving a portion 35 bent withrespect to flat portion 25, portion 35 then being approximately parallelto the back leg 34 of the book. This construction assures a correctbending about points 27 and 28 and a straightening of element 24 asillustrated in FIG. 5.

In addition to faciliating closure, reverse bend 29 confers otherdistinct advantages. First, it increases the opening between hook end 32and closure arm end 33 so that the surgeon may more easily introducevessels into the inside of the hemostatic clip. Second, it is bend 29which makes it possible for hook end 32 to close into a position in linewith portion 25 (FIG. 5). This coplanar condition produces a closedhemostatic clip with no free ends to pierce surrounding tissue. Third,bend 29, in conjunction with the three layers of wire in the clench area(portion 35, and hook sides 34 and 32) preserves the size of the openspace occupied by vessel 30. This assures that the opening between theparallel arms of the closed hemostatic clip (portion 23 and portion 25)is always the same, regardless of the amount of pressure used to closejaws 11 and 12. Because of this built-in safeguard, a surgeon cannot cuta vessel by closing the hemostatic clip too tightly, while permitting acomplete clenching, and a more rapid hemostasis operation isfacilitated.

Recapitulating, the clip may be described as having a straight backportion 23 which is connected at a first bend 24' to the front closuremember 24, and which is connected at the reverse bend 29 to the hook 26.The length of the wire forming the front closure member 24 is greaterthan the straight line distance from the bend 24 to the outer end of thehook 26; yet, the outer end of the bowed closure member 24 is fartherfrom the bend 24' than is the outer end of the hook 26. The presence ofthe reverse bend 29 causes one leg 34 of the hook 26 to lie on anopposite side of the longitudinal axis of the back portion 23 from thefront closure member. The reverse bend is closer to the hook-formingbend 27 than to the bend 24; and, the outer leg 32 of the hook 26 isshorter than the leg 34 which extends immediately from the reverse bend.

While a preferred form of the hemostatic clip has a shape generally asat 20, including the reverse bend at 29, the latter may be omitted andthe back portion left straight as at 31 in FIG. 7, but lacks theadvantages of bend 29 noted above, but it can be made to function if itis properly proportioned. Closure arm 24 should be about ten percentlonger than the length of back portion, exclusive of portion to becovered by the hook. The length of the hook may approximate one-quarterof the length of the upper arm. The hook and the upper arm must be benton suitable radii so that, on closing, end 33 clears end 32, whileappropriate clenching can still be accomplished.

The preferred form of hemostatic clip is applied in closing a bloodvessel by placing back element 23 either in channel 16 or 17 restingagainst pin 19 with point 33 of the front portion resting in theopposite channel, there held under slight pressure such that clip 20will not slide from channels 16 and 17 during placement of the jawsaround vessel 30. Upon inserting vessel 30 within a clip placed onapplicator jaws and adjacent to pin 19, member 44 may be rotated to theunlocked position and the jaws may then be closed by a quick graspingaction on the handles whereby the jaws are forced together to close andlock the clip. During the clamping operation, portion .24 first bendsprimarily around center 28 until point 33 comes into contact with theclip back 23, or portion 34 beyond bend 29. Further closure of the jawscauses point 33 to advance along the slope 34 until it passes a positionbeneath point 32 or hook 26. Further pressure on jaws 11 and 12 causesincreased bending to occur at the end 37 of the clip and a sharpendingof the bend 36 around center 27 until point 32 engages portion 35adjacent point 33 then in contact with portion 34. The clip is thusclosed and firmly clenched. FIG. 4 illustrates an intermediate closureposition wherein a blood vessel 30 placed in the jaws of an applicatoras in FIG. 3 is partially closed oif, being shown fully closed in FIG. 5wherein the clip is locked by closure of hook point 32 over end 35 ofthe closure element.

A clip formed as in FIG. 7 is closed and clenched in substantially thesame way by causing bowed portion 24 to be flattened against backportion 23 with point 33 underlying point 32 of hook 26 as the clip isclosed into its flattened condition to clench therein point 33.

By means of apparatus as illustrated a positive and easy application ismade of a homostatic clip of minimum size requiring only a few secondsfor each application. It will be appreciated that an improved method ofclosing blood vessels is achieved by the use of the applicator and clip,and that this method of hemostasis permits much more rapid tying off ofblood vesels, with better security from slippage or accidental openingby virtue of the clenching operation inherent in the closing of hook 26to clench and retain therein end 35 of the front closure member whenstraightened as at 25.

While the invention has been described with respect to particularembodiments, it is intended that the invention be not so limited butthat it include all equivalents within the scope of the followingclaims.

What is claimed is:

1. A hemostatic clip formed from an elongated member, comprising asubstantially straight back portion,

a bowed front closure member extending from one end of the back portionat a first bend, said front closure member having an outer end disposedtransversely from the back portion,

a hook extending from another end of the back portion and terminating inan outer end of the elongated member, said hook having two legsinterconnected by a second bend and located to form an open slot facinggenerally toward the front closure member,

6 and a third bend at the juncture of the hook and the end of the backportion to locate one leg of the hook on an opposite side of thelongitudinal axis of the back portion from the front closure member.

2. A hemostatic clip according to claim 1 in which the leg of the hookwhich extends from the back portion is longer than the other leg of thehook.

3. A hemostatic clip according to claim 2 in which the first bend iscloser to the third bend than to the outermost end of the bowed frontclosure member.

4. A hemostatic clip according to claim 3 in which the Zhirg bend iscloser to the second bend than to the first 5. A hemostatic clipaccording to claim 2 in which the single elongated member is afiat-sided wire having a uniform thickness.

6. A hemostatic clip according to claim 1 in which the first bend iscloser to the third bend than to the outermost end of the bowed frontclosure member.

7. A hemostatic clip according to claim 6 in which the single elongatedmember is a flat-sided wire having a uniform thickness.

8. A hemostatic clip according to claim 6 in which the third bend iscloser to the second bend than to the first bend.

9. A hemostatic clip according to claim 1 in which the single elongatedmember has a uniform thickness.

10. A hemostatic clip according to claim 9 in which the single elongatedmember is a fiat sided wire.

11. A hemostatic clip according to claim 1 in which the third bend iscloser to the second bend than to the first bend.

12. A hemostatic clip according to claim 1 having the followingcharacteristics:

(a) the elongated member is a flat wire of uniform thickness;

(b) the distance from the first bend to the free end of the hook isgreater than the straight line distance from the first bend to the outerend of the front closure member and less than the length of the wire inthe front closure member;

(c) the second bend is closer to the free end of the hook than to thethird bend; and

(d) the third bend is closer to the second bend than to the first bend.

13. The method of hemostasis including the steps of placing a bloodvessel between the back portion and the front closure member of thehemostatic clip described in claim 1, bending the clip to bring thefront closure member toward the back portion until the outer end of thefront closure member contacts the elongated member adjacent the thirdbend, bending a major portion of the bowed front closure member intoparallelism with said back portion, and bringing the legs of the hooktogether to engage the outer end of the front closure member.

References Cited UNITED STATES PATENTS 3,270,745 9/1966 Wood 1283253,120,230 2/1964 Skold 128325 2,598,901 6/1952 Garland 24--30.5

F. BARRY SHAY, Primary Examiner GREGORY E. MCNEILL, Assistant ExaminerUS. Cl. X.R.

1. A HEMOSTATIC CLIP FORMED FROM AN ELONGATED MEMBER, COMPRISING ASUBSTANTIALLY STRAIGHT BACK PORTION, A BOWED FRONT CLOSURE MEMBEREXTENDING FROM ONE END OF THE BACK PORTION AT A FIRST BEND, SAID FRONTCLOSURE MEMBER HAVING AN OUTER END DISPOSED TRANSVERSELY FROM THE BACKPORTION, A HOOK EXTENDING FROM ANOTHER END OF THE BACK PORTION ANDTERMINATING IN AN OUTER END OF THE ELONGATED MEMBER, SAID HOOK HAVINGTWO LEGS INTERCONNECTED BY A SECOND BEND AND LOCATED TO FORM AND OPENSLOT FACING GENERALLY TOWARD THE FRONT CLOSURE MEMBER, AND A THIRD BENDAT THE JUNCTURE OF THE HOOK AND THE END OF THE BACK PORTION TO LOCATEONE LEG OF THE HOOK ON AN OPPOSITE SIDE OF THE LONGITUDINAL AXIS OF THEBACK PORTION FROM THE FRONT CLOSURE MEMBER.